Gs. Rozycki et al., SURGEON-PERFORMED ULTRASOUND FOR THE ASSESSMENT OF TRUNCAL INJURIES -LESSONS LEARNED FROM 1540 PATIENTS, Annals of surgery, 228(4), 1998, pp. 557-565
Objective To determine the accuracy of the Focused Assessment for the
Sonographic examination of the Trauma patient (FAST) when performed by
trauma team members during a 3-year period, and to determine the clin
ical conditions in which the FAST is most accurate in the assessment o
f injured patients. Summary Background Data The FAST is a rapid test t
hat sequentially surveys the pericardial region for hemopericardium an
d then the right and left upper quadrants and pelvis for hemoperitoneu
m in patients with potential truncal injuries. The clinical conditions
in which the FAST is most accurate in the assessment of injured patie
nts have yet to be determined. Methods FAST examinations were performe
d on patients with precordial or transthoracic wounds or blunt abdomin
al trauma. Patients with a positive ultrasound (US) examination for he
mopericardium underwent immediate surgery, whereas those with a positi
ve US for hemoperitoneum underwent a computed tomography scan (if they
were hemodynamically stable) or immediate celiotomy (if they were hem
odynamically unstable - blood pressure less than or equal to 90 mmHg).
Results FAST examinations were performed in 1540 patients (1227 with
blunt injuries, 313 with penetrating injuries). There were 1440 true-n
egative results, 80 true-positive results, IB false-negative results,
and 4 false-positive results; the sensitivity was 83.3%, the specifici
ty 99.7%, US was most sensitive and specific for the evaluation of pat
ients with precordial or transthoracic wounds (sensitivity 100%, speci
ficity 99.3%) and hypotensive patients with blunt abdominal trauma (se
nsitivity 100%, specificity 100%). Conclusions US should be the initia
l diagnostic modality for the evaluation of patients with precordial w
ounds and blunt truncal injuries because ii: is rapid and accurate. Be
cause of the high sensitivity and specificity of US in the evaluation
of patients with precordial wounds and hypotensive patients with blunt
torso trauma, immediate surgical intervention is justified when those
patients have a positive US examination.